Implantation of a blastocyst within the endocervical canal is termed a"cervical pregn-ancy", which is one of the most dangerous forms of ectopic pregnancy. It is even less common, but the incidence appear to be increasing, in part due to newer forms of assisted reproduction. Proper management is indicated as soon as the diagnosis is suspected. Hemorrhage may be massive and sometimes fatal. In the past, hysterectomy was often the only choice available because of profuse hemorrhage that accompanied attempts at removal of the cerv- ical pregnancy. We report two cases of cervical pregnancy treated conservatively without hysterect- omy. Hemorrhage from the implantation site was controlled by intracervical placement of a Foley catheter balloon without hemostatic cervical sutures at 3 and 9 o clock. Immediate insertion of a Foley catheter into the cervical canal and inflation of the catheter bulb after endocervical suction curettage appears to be a simple and effective technique of managing cervical pregnancy in a patient who wishes to maintain childbearing capacity.
Blastocyst ; Catheters ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Inflation, Economic ; Pregnancy* ; Pregnancy, Ectopic ; Reproduction ; Sutures ; Vacuum Curettage

Sertoli-Leydig cell tumor is an uncommon tumor that may manifest itself by a characteri-stic virilization symptom. It is a rare gonadal tumor of sex-cord type, representing only 0.1~0.5% of all primary ovarian neoplasm. These tumors are the most common virilizing tumors in women of reproductive age. However, only one-third of patients develop masculinization. We have seen two cases of Sertoli-Leydig cell tumors without the virilizing symptom. These two cases have been confirmed by permanent tissue biopsies and have been presented in a 32-year old female who has had only amenorrhea and in a 56-year old postmenopausal female who has not manifested virilizing symptom. These cases are presented with brief review of the literature.
Adult ; alpha-Fetoproteins ; Amenorrhea ; Biopsy ; Female ; Gonads ; Humans ; Middle Aged ; Ovarian Neoplasms ; Sertoli-Leydig Cell Tumor* ; Testosterone ; Virilism

PURPOSE: COX-2 is known to be elevated in breast cancer, but the clinical relevance is still a matter of debate. The purpose of this study was to determine the prognostic significance and relationship of COX-2 to hormone receptors. METHODS: Between January 2005 and February 2007, 80 specimens from breast cancer patients at Korea University Anam Hospital were reviewed by one pathologist. COX-2 was analyzed as overexpressed if >10% of the cells were stained. Clinical characteristics, hormone receptor status, and other prognostic factors were investigated to determine their association with COX-2 expression. RESULTS: COX-2 was overexpressed in 12 patients (15%). Two patients had locoregional recurrence, eight patients had systemic metastasis, and one patient died. There was no statistically significant correlation between COX-2 expression and age, size, nodal status, histological grade, hormone receptor status, and HER-2/neu positivity. Among tumors that had a positive expression of ER and PR, COX-2 expression was related to larger size (P-value 0.001 and 0.009, respectively) and nodal status (P-value 0.048 and 0.009, respectively). However, there was no statistically significant correlation with tumors that had negative ER or PR expression. CONCLUSION: This study suggests that in breast cancer, COX-2 expression has no relationship with clinicopathologic factors; however, a correlation was noted in size and nodal status for ER- and PR-positive tumors. Further prospective study with larger population to clarify the relationship between COX-2 expression and hormone receptor status is necessary.
Breast ; Breast Neoplasms ; Cyclooxygenase 2 ; Humans ; Korea ; Neoplasm Metastasis ; Receptors, Progesterone ; Recurrence

PURPOSE: Distant metastasis and recurrence are major prognostic factors associated with breast cancer. Both lymphovascular invasion (LVI) and blood vessel invasion (BVI) are important routes for metastasis to regional lymph nodes and for systemic metastasis. Despite the importance of vascular invasion as a prognostic factor, application of vascular invasion as a histopathological criterion is controversial. The aim of this study was to distinguish LVI from BVI in prognosis and recurrence of breast cancer using an endothelial subtype specific immunohistochemical stain (podoplanin, D2-40, and CD31). METHODS: Sections from 80 paraffin-embedded archival specimens of invasive breast cancer were stained for podoplanin, D2-40, or CD31 expression. Immunohistochemical staining results were correlated with clinicopathological features, such as tumor size, status of lymph node metastases, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor-2 expression, and recurrence. Patients with ductal carcinoma in situ and stage IV breast cancer were excluded. RESULTS: A significant correlation was found between D2-40 LVI positivity and lymph node metastasis (p=0.022). We found a significant correlation between D2-40 LVI positivity and recurrence of breast cancer (p=0.014). However, no significant correlation was found between BVI and recurrence. A poorer disease free survival was shown for D2-40 positive LVI (p=0.003). In a multivariate analysis, the presence of D2-40 LVI positivity revealed a significant association with decreased disease-free survival. CONCLUSION: D2-40 LVI positivity was a more prognostic predictor of breast cancer than BVI.
Antibodies, Monoclonal, Murine-Derived ; Antigens, CD31 ; Blood Vessels ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Disease-Free Survival ; Epidermal Growth Factor ; Estrogens ; Glycosaminoglycans ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Receptors, Progesterone ; Recurrence

Background: Delta checks increase patient safety by identifying automated hematology analyzer errors. International standards and guidelines for the complete blood count (CBC) delta check method have not been established. We established an effective, practical CBC delta check method and criteria. Methods: We assessed five delta check methods for nine CBC items (Hb, mean corpuscular volume, platelet count, white blood cell [WBC] count, and five-part WBC differential counts) using 219,804 blood samples from outpatients and inpatients collected over nine months. We adopted the best method and criteria and evaluated them using 42,652 CBC samples collected over two weeks with a new workflow algorithm for identifying test errors and corrections for Hb and platelet count. Results: The median delta check time interval was 1 and 21 days for inpatients and outpatients (range, 1–20 and 1–222 days), respectively. We used delta values at 99.5% as delta check criteria; the criteria varied among the five methods and between outpatients and inpatients. The delta percent change (DPC)/reference range (RR) rate performed best as the delta check for CBC items. Using the new DPC/RR rate method, 1.7% of total test results exceeded the delta check criteria; the retesting and resampling rates were 0.5% and 0.001%, respectively. Conclusions We developed an effective, practical delta check method, including RRs and delta check time intervals, and delta check criteria for nine CBC items. The criteria differ between outpatients and inpatients. Using the new workflow algorithm, we can identify the causes of criterion exceedance and report correct test results.

PURPOSE: To reduce the side effects and improve the effectiveness of standard chemoradiation therapy, many complementary or alternative medicines have been tried. However, little is known about its immunologic effects in breast cancer patients. The aim of this study was to assess the immunologic effects of mistletoe extract (Viscum album L., VAE) in patients with early breast cancer after surgery followed by standard adjuvant chemoradiation therapy. METHODS: A total 20 patients with early breast cancer treated with breast conserving surgery followed conventional chemoradiation therapy. Ten of these patients received subcutaneous injections of VAE for 7 weeks. IL-2, IL-4, IL-6, IL-10, TGF-beta, and IFN-gamma levels in serum samples were measured in all patients. RESULTS: The concentrations of IL-2, IL-4, IL-10, and TGF-beta were not significantly changed between before and after VAE treatment in both test and control group. The concentration of IL-6 in the test group was increased from 8.19+/-1.75 pg/mL to 9.86+/-1.46 pg/mL after treatment (p=0.013). The concentration of IFN-gamma in the test group was remarkably increased from 91.76+/-17.16 pg/mL to 167.42+/-66.61 pg/mL after treatment (p=0.009). CONCLUSION: Significant increases in the concentration of IL-6 and IFN-gamma were observed after VAE treatment. These results suggest that VAE treatment can stimulate immune responses, especially cell-mediated immunity in immune-compromised patients received the chemoradiation for breast cancer.
Breast ; Breast Neoplasms ; Humans ; Immunity, Cellular ; Injections, Subcutaneous ; Interleukin-10 ; Interleukin-2 ; Interleukin-4 ; Interleukin-6 ; Mastectomy, Segmental ; Mistletoe ; Transforming Growth Factor beta

BACKGROUND: In hypovolemic shock, multiple organ failure is caused by translocation of endotoxins and microorganisms from the ischemic gut mucosa. Therefore, much attention has been paid to the gut mucosa oxygenation in shock resuscitation. The current guidelines on cardiopulmonary resuscitation restrain the use of sodium bicarbonate due to paradoxical intracellular acidosis. Because THAM, CO2-consuming agent, does not produce CO2 and induce intracellular acidosis, THAM has been known as a effective buffering agent. This study was purposed to investigate the effect of THAM and sodium bicarbonate on the gut mucosa oxygenation in cats which were in hemorrhagic shock and resuscitation. METHODS: 18 anesthetized cats were subjected to hemorrhage to decrease the mean arterial blood pressure to 35-45 mmHg and this blood pressure was maintained for 120 minutes. After 90minutes, we infused 1.945% hypertonic saline, 2.8% sodium bicarbonate and 0.3M THAM as same volume and osmolality. Mean arterial pressure(MAP), mesenteric arterial-venous pH differences[pH(a-v)], mesenteric venous oxygen tension(PvO2), mesenteric arterial-venous carbon dioxide tension differences[P(v-a)CO2], mesenteric arterial-venous lactate differences[Lactate(v-a)] were measured 1, 5, 15, 30 minutes after drug infusion and 30, 60 minutes after reperfusion. RESULTS: There were no statistical significances in MAP, pH(a-v), PvO2, Lactate(v-a) among the three groups. There were significant differences in P(v-a)CO2 and ETCO2 between sodium bicarbonate group and THAM group. CONCLUSIONS: This study suggest that THAM and sodium bicarbonate do not have significant effects on the tissue oxygenation and hemodynamic improvement in hypovolemic shock. We suppose that THAM does not produce carbon dioxide but may correct intracellular acidosis.
Acidosis ; Animals ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Cardiopulmonary Resuscitation ; Cats* ; Endotoxins ; Hemodynamics ; Hemorrhage ; Hydrogen-Ion Concentration ; Lactic Acid ; Mucous Membrane* ; Multiple Organ Failure ; Osmolar Concentration ; Oxygen* ; Reperfusion ; Resuscitation ; Shock ; Shock, Hemorrhagic* ; Sodium Bicarbonate* ; Sodium* ; Tromethamine*

No abstract available.
Chromosome Aberrations ; Humans ; Karyotype ; Leukemia, Myeloid, Acute/*diagnosis/etiology/mortality ; Myelodysplastic Syndromes/complications/*diagnosis ; Myeloproliferative Disorders/complications/*diagnosis ; Philadelphia Chromosome ; Survival Rate